​The mentally ill are not alone in Kenya

There are too few psychiatrists, so a foundation is using a Canadian model to rehabilitate people.

Kiima Kimwe* (37) whistles cheerfully as he unlocks the shop and sets about his morning routine. He switches on equipment, straightens stacks of paper and wipes down the counters.
"I like it here," he says. "It makes me feel normal."

Kimwe's six co-workers arrive one by one, smart in white and blue shirts. "For me it is therapeutic to work with them," Kimwe explains. "They have been through the same experiences as me."

The photocopy and printing shop appears no different from any other in the sprawling town of Machakos, 80km south of the Kenyan capital, Nairobi. Few of the customers have any idea that the shop is run by recovering mental health patients.

Until recently Kimwe had no prospect of working after his life fell apart five years ago. First came the ghosts only he could see. Then the voices no one else could hear.

His wife, Lucy*, no longer recognised the soft-spoken man she had known and loved for nearly 10 years and Kimwe's erratic behaviour scared her. Their bewildered children were not only afraid of their father, but also ashamed.

"It was the most terrifying experience of my life," she recalls. "I didn't know how to explain his behaviour to the children."

Unpredictable behaviourKimwe had made a living doing odd jobs, but as he became more and more unpredictable, the work dried up.

Everyone was avoiding the family. Lucy felt the stares from the neighbours, heard the gossip among relatives and friends. "I almost went into a state of depression. The stigma was unbearable."

One morning, it all became too much. Lucy left their two-bedroomed house in Machakos, taking their three young children.

Kimwe's family members took him to the district hospital, where he was diagnosed with schizophrenia. The mental condition is a severe brain disorder in which people interpret reality abnormally, according to the Mayo Clinic, the United States-based medical research organisation. It could result in some combination of hallucinations, delusions and extremely disordered thinking and behaviour. There is no known cause. Schizophrenia is a chronic condition that requires lifelong treatment.

Kimwe started a treatment programme that includes medication and weekly therapy sessions at the district hospital's mental health department. There, he was helped by the Nairobi-based African Mental Health Foundation.

Victoria Mutiso, director of research at the foundation, says the organisation started its Community Recovery Achieved Through Entrepreneurship (Create) project to offer psychosocial support and rehabilitation to recovering patients.

Although reliable data on the state of mental illness in Kenya is not available, "the problem of mental illness is more widespread in Africa than many people might know", Mutiso says.

Mental disordersThe World Health Organisation's figures show that one in four people worldwide will be affected by mental or neurological disorders at some point in their lives.

There were only 46 psychiatrists in Kenya's entire public health sector in 2009 and 24 in private practice, according to research published in 2010 in the International Journal of Mental Health Systems. At Machakos hospital there was just one psychiatrist for the district. About six psychiatrists graduate each year, but many of them join the small private sector, teach at universities or work in Nairobi. This leaves a huge proportion of Kenyans in rural areas with no access to qualified mental health specialists, Mutiso says.

"Many of these people don't get treatment due to factors such as failure of family members or even health workers to recognise the disease. Medical workers, nurses, clinical officers and community health workers often do not have the skills to diagnose mental illness. Generally only those with chronic conditions get treatment."

Kimwe says the Create project helped him to rebuild his life and saved his marriage.
Foundation employees arranged five counselling sessions for Lucy at the hospital in Machakos.
"Through the counselling Lucy understood that mental illness is a disease like any other," Kimwe explains. "We are back together and she's very supportive."

Mental patients often lose their jobs, can't own property or even marry. They may end up in a life of poverty regardless of whether they have fully recovered or possess the skills to support themselves, according to Mutiso.

Support for those with mental illnessCreate helps people with mental illnesses to find jobs so that they can support themselves.

The photocopy and printing shop where Kimwe works, was started specifically for recovering mental health patients. Once a week, the group is counselled at the shop by a professional.

"This is a model we borrowed from Canada," Mutiso says. "Depending on the outcome of the Machakos project, we hope to scale it up and reach more patients."

Create's project development officer, Ruth Ruhara, says the seven employees at the Machakos shop have post-school qualifications, but are not able to find jobs.

"We teach them to view themselves as normal persons, as human beings. This business helps a lot in avoiding self-stigmatisation because they have a place to wake up and go to each morning and this also helps in recovery," Ruhara says.

Those who do know recovering patients are running the shop have no problem frequenting the business. This, according to Ruhara, is an indication that stigma can be overcome.

Kimwe finishes counting a customer's change before he turns around and, with a slow smile, says: "My children know I am looking after them and earning money. Here I believe in myself." — Additional reporting by Adri Kotze